APPLICATION FOR FAMILY PENSION

(TO BE FILLED IN AND SIGNED BY THE APPLICANT HIMSELF/HERSELF)

To

The ……………………………
……………………………………………
………………………………………..

Dear Sir,

I have the honour to say that my husband/wife/* …………………………………………..

Has expired on (date) ………………………………………. I, therefore, request that the family pension
admissible under the rules may kindly be sanctioned to me.

2. I declare that I have neither applied for nor received any family pension.
3. Should the amount of the family pension granted to me be afterwards found to be the excess of
that to which I am entitled under the rules, I hereby undertake to refund any such excess.

4. I wish to draw my pension from the District Accounts Office/Government Treasury/Sub-

Treasury/National Bank of Pakistan Br at (place) ……………………………………
5. The following documents, duly attested, are enclosed:-

(i) Three specimen signatures of mine duly attested/two sets of my thumb and finger
impressions o the prescribed form.
(ii) Three photographs of mine.
(iii) List and particulars of \family members
(iv) Descriptive Roll.
(v) Death Certificate
(vi) Non-remarriage and non separation certificates.

Yours faithfully,

Widow/Husband/entitled member of the

family

Dated _______________________
 To

1. The Accountant General Punjab, Lahore.

2. The District Accounts Officer ______________.

Subject: Grant of Family Pension to Mst. _______________________________________

W/o __________________________________ holder of P.P.O. No. ________________

Sir,
It is submitted that my husband Mr. ________________________________ s/o
_______________________________________ has died on _____________________. He was an
employee of ______________________________________________________.

2. Now I am the only and lawful widow of the deceased. Hence I request to kindly issue me family
pension payment order so that I may receive the familypension payment order so that I amy receive the
family pension.

The following documents are enclosed with the application for necessary:

(i) Death Certificate

(ii) List of family members
(iii) Descriptive roll of widow
(iv) Non-remarriage certificate
(v) Certificate of lawful widow
(vi) Photocopy of old P.P.O.

Yours faithfully,

Dated: ________________ Mst. _______________________

W/o _______________________
Address _____________________
____________________________
LIST OF FAMILY MEMBERS OF ______________________________________

I solemnly declare and affirm that my family members are as under:-

Sr.No. Name of Member Relationship Age Married/

Unmarried

I further declare that there is no other family member except those mentioned above.

ATTESTED
 APPENDIX II
Form of Descriptive Roll
Descriptive of Roll of Mst. ________________________________________________________________
widow/Son/Daughter/Wife of Mr.(Late) _____________________________________________________
_______________________________________________District ________________________________
1. Name _________________________________________________________________________
2. Race __________________________________________________________________________
3. Resident of _____________________________________________________________________
4. Father’s Name __________________________________________________________________
5. Height __________________________________ Feet __________________________________
6. Age ___________________________________________________________________________
7. Colour of hair ___________________________ Colour of Eyes ___________________________
8. Personal Mark, if any, on head ______________________________________________________
Face etc. _______________________________________________________________________
9. Place of Payment: Government Treasury or Sub Treasury ________________________________
10. Signature of Right Hand or Thumb Impression and Finger Impression ______________________

Little Finger _____________________________ Ring Finger ____________________________________

Middle Finger ____________________________Fore Finger ____________________________________

Thumb Impression ______________________________________________________________________

ATTESTED

Note: Descriptive roll form and list of family members is to be filled in duplicate.
 NON-REMARRIAGE CERTIFICATE

1. I, Mst. ______________________________________________________________________________
Widow of late Mr. _______________________________________________________________________
serving as ___________________________________ in _____________________________ department
do hereby declare that I am the sole widow of late Mr. _______________________________________.

2. I further declare that I have not been married after the death of my late husband and am residing as
widow with my children.

Signature

We certify to the best of our knowledge and belief that the above declaration is correct and accept full
responsibility for it.

1. Signature with Designation ____________________________________________

2. Signature with Designation ____________________________________________

Date: ___________________________